How Diabetes Affects Wound Care

With November being Diabetes Awareness Month and being a wound care nurse myself, I thought I would write about something that relates to both diabetes and wounds.

To give you all a little wound care 101, there are three phases in wound healing: inflammation, proliferation and maturation, also called the remodeling phase. Wound healing is a very complex series to say the least and there are many cellular activities that happen in each of the phases. If something goes wrong in any of the phases, there is a delay in wound healing.

The factors that contribute to wound healing are both local and systemic. One factor is uncontrolled blood glucose in the diabetic patient. What does hyperglycemia (high blood glucose) do to the wound healing process? Well, for starters, it prolongs the inflammatory phase of wound healing. That means the wound has to work harder to clean up and get all of the bad stuff out. We want blood to get to the wound and clean it up as fast as it can, but circulation is sluggish when sugars are high, causing slough to build up in the wound.(Slough is defined as soft moist devitalized tissue).

Hyperglycemia in a wound care patient also causes reduced collagen synthesis. Collagen is the backbone of our skin. Think of it as a matrix of tight strings. We want our skin to be tough, right? If hyperglycemia causes reduced collagen synthesis, then our new skin will be more fragile. This will decrease the tensile strength of the skin. A scar that forms will be weaker and therefore is more vulnerable to re-opening.And we sure don’t want that.

Epithelial migration occurs in the maturation or remodeling phase of wound healing. This is the process when new epithelial or skin cells “float” across the granulation tissue (good tissue) and come together to close the wound. If the blood sugar is elevated, epithelial migration is impaired, which means a delay in wound healing.

Lastly, and probably most importantly, uncontrolled blood glucose levels cause compromised vasculature or circulation. For a wound to heal properly, two things need to be in place: 1) blood flow and 2) nutrition.

The wound needs essential nutritional components, but if the patient doesn’t have blood flow to get them to the wound, there will be a delay in wound healing.If the patient has great nutrition, but no means to get the nutrients to the wound, there will be a delay in wound healing.

The bottom line is: good glycemic control will help heal a wound faster!!